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NPI Code Detail

MEDICARE: TIFFANY JOI VAUGHN NP-C

MEDICARE: TIFFANY JOI VAUGHN NP-C
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1363LF0000XFamily Nurse Practitioner343637NY

General Provider Information

NPI Number : 1750866810
Entity Type Code : Individual
Provider Name (Legal Business Name) : TIFFANY JOI VAUGHN NP-C
Provider Business Mailing Address
First Line : 80204A N LEWIS ST
Second Line :
City : FORT DRUM
State : NY
Zip : 13603-4091
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 19316 US ROUTE 11
Second Line : BUILDING IV, SUITE C
City : WATERTOWN
State : NY
Zip : 13601
Country : US
Telephone Number : 315-681-4192
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/25/2018
Last Update Date : 09/25/2018

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